Academy of Chiropractic

Quickie Podcast 1293
Compliance and Insurance 68 CA

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

Writing IME Rebuttals

Dr. Studin: I'm on with Dr. Rodman, Tony. Good morning. Okay. Set up the situation. Go ahead. 

Guest: I have a situation where I did a rebuttal on it for a doc and it was centered around computer guys, radiograph ministration analysis. They were denying it for a variety of reasons. Um, not fully researched, et cetera, et cetera. And I supplied a wealth of references and to answer their questions, he came back with a rebuttal on the rebuttal indicating, uh, saying the sexually another chiropractor saying, well, the yield is not that great. Uh, the MRI.

Dr. Studin: Okay. For any more information, it's not getting any additional information than an MRI, correct. 

Guest: Well, that's one indication, but that's not the crux of it. They never answered the questions that I answered and pose to them. Well, this, and this, and they never answered it. So it's the same thing. So my question is, can I reiterate everything or just, you know, send these guys up to, uh, examiners, send them up to the board of examiners actually. 

Dr. Studin: Um, this is the issues I would in this particular case, I would,  this is a carrier issue and the doc and again, board of examiners issue. So I would put the character notice that, well, first you can send them to the board of examiners. The doctor didn't lie. They just ignored the issue. They completely, so it takes me off. Well, it's not it's I know it you off, but you can't report them to the licensure board because they didn't lie or break the law. They just, they just didn't answer the question. So now you have to pose it to the carrier that in fact, you did and I and me a rebuttal was done to answer the direct questions. Then you hired a second by AMA, which posed the exact same questions as the first doctor and never responded to your issues. Or did the guy have a new The first one was breathless. The second guy said that it doesn't change your diagnosis, prognosis and treatment plan pretty much correct? 

Guest: Yes. 

Dr. Studin: Okay. I went to great detail on the references. So they're doing is they're coming up with a different reason now. So you have to respond to the new reason and you have to say, it appears that your first set of denials, we've resolved those issues. Now you have additional issues, which we appreciate, and then you have to get into how, uh, the x-ray digitizing, um, does not handle what MRI handles it doesn't look at. And you could use the two articles on pathology. It doesn't determine biomechanical, go back to Penn, Javi and white.  got all the stuff in there. This was all answered in the first rebuttal. Oh. So all. Okay. So you'll have to say, then you can save  then everything you just discussed is answered in the first rebuttal. And none of this, is sequella to MRI. None of it. I would say that. So, um, and I would write dear dr. So-and-so, in case you did not read the first rebuttal, please find the attached first rebuttal. 

Guest: Okay. And then should you choose to ignore it for the second time? 

Dr. Studin:I will then consider that an omission of, of, of contributory facts, which then can be construed as a licensure issue. Okay. Do you understand? 

Guest: Yes

Dr. Studin: it should be very short. Two paragraphs, write it up and send it to me first. 

Guest: Okay. Thank you.

 

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